June 28, 2010
Findings from a study of the Diabetes Support in School Scale (DSSS) demonstrate that the tool provides a “comprehensive and valid” measure that may be useful in assessing the adequacy of care and support for children with diabetes in the school setting.
During an oral presentation given at the ADA 70th Scientific Sessions, Doreen Radjenovic, PhD, addressed the need for schools to provide education in the classroom setting with specific health-related accommodations, and identified the barriers to necessary health services for school children with diabetes.
“There are no best practices available to facilitate self-management of diabetes in schools,” she said. “Further, existing school support instruments have not been tested for validity or reliability.”
With that mind, Radjenovic and colleagues examined the policies in place to accommodate children with diabetes in school. They created a questionnaire, revising it with the help of an expert panel to ensure that questions were both clear and valid, and distributed it at Morse Children’s Clinic in Jacksonville, FL, to a sample of 76 parents of children with type 1 diabetes. Parents were asked about the type of support their children received in school during the past month, with questions focusing on specific issues such as whether the school nurse makes sure that their child is given insulin in a timely manner.
Consistent with their hypothesis, the group found that satisfaction ratings were highest in parents whose children attend a school with a full-time nurse, followed by those whose children attend a school with a part-time nurse, and finally by those whose children go to a school that does not have a nurse.
Radjenovic and colleagues concluded that DSSS is a reliable and valid measure of school support, and may serve as an outcome measure in studies to determine best practices for diabetes-related school health services/policies. The group plans to publish the manuscript in the near future, she noted.
In a later presentation, Sanjeev Mehta, MD, of Joslin Diabetes Center, reviewed findings of a study, entitled, “Validation of a Self-report Measure to Assess Adherence in Youth with Type 1 Diabetes,” which aimed to evaluate the effectiveness of a diabetes management questionnaire (DMQ) in improving adherence in children age eight and under with type 1 diabetes.
Management of the disease, he said, “requires attention to multidisciplinary, self-care behaviors,” through methods such as structured interviews, direct observation, and self-administered paper surveys.” Adherence is critical, as it is directly associated with improved glycemic control with patients with type 1 diabetes.
The questionnaire measured responses based on behaviors over the past month, including physical activity, meal planning, and hypoglycemic measurements, asking questions such as how often did you or your parent check blood sugar before physical activity or miss an insulin dose. The DMQ scores were higher for those who checked blood sugar more frequently and didn’t miss insulin injections, said Mehta.
He concluded that the questionnaire is “a brief, self-administered measure to adherence for diabetes management” that “demonstrated good reliability and validity, including a significant inverse association with A1C.”
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